Provider Demographics
NPI:1598215592
Name:CHE, IRENE KIEN
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:KIEN
Last Name:CHE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:IRENE
Other - Middle Name:KIEN
Other - Last Name:CHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW
Mailing Address - Street 1:2525 YOUREE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3671
Mailing Address - Country:US
Mailing Address - Phone:318-675-0804
Mailing Address - Fax:318-425-9030
Practice Address - Street 1:2525 YOUREE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3671
Practice Address - Country:US
Practice Address - Phone:318-675-0804
Practice Address - Fax:318-425-9030
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009497475101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor